Words by Natasha den Dekker, Visuals by Austin Smoldt-Saenz
In 2020, in the wake of the COVID-19 epidemic, England embarked on an ambitious journey—to create a nationwide COVID vaccination program to be rolled out to all citizens on a staggered basis.
This had never been done before. Even the flu vaccine is managed at a regional level and while comparable, doesn’t really come close. Furthermore, it had never been done on an accelerated time scale where the vaccines were still in production and being bought.
So where do I, a fairly new UX Researcher (as of 2020) fit in?
England’s COVID Vaccination Program
I was working as a User Research Consultant for an agency in England that specialized in public sector contracts. My company won a contract for a member of our team to join a joint task force of multiple researchers, service designers, and UX Designers from multiple health agencies and consultancies to work on the COVID Vaccinations programme.
Multiple health departments were working on the following areas within the development of the COVID Vaccination Program in England. Just a few of those included:
- Test and trace app
- Regular updates about the virus
- Vaccination centers
- GP surgeries
- Vaccine transport
- How to upskill healthcare providers to administer the vaccines
- Making medical records accessible across digital platforms
- Procurement of different vaccines
The sheer breadth of work was why there were multiple consultancies brought in to work on the project, and why researchers were being cycled on and off the project to prevent burnout. It was impressed upon us that we were working to a very strict deadline with a need to understand very specific factors.
What’s the best way to contact patients to tell them to go and get the vaccine?
Our focus was: how are our most vulnerable members of the population going to be contacted? Previous research indicated that patients would respond better to requests coming via their general practitioner (GP) as opposed to government or any other members of the community.
We started off with two potential assumptions:
- Sending a text would be the most effective way to contact this population
- All these users had mobile phones
We needed to get this information, as it was going to the most vulnerable members of the population who were going to be vaccinated first and would therefore need to be contacted ASAP. We needed to know how to do that as effectively as possible, and research was required to assess if these assumptions were accurate or needed to be changed.
Where was my prior knowledge useful?
My experience of working in the National Health Service (NHS) meant that I knew the difference between a Clinical Commissioning Group (CCG) and a Primary Care Network (PCN). This knowledge was important in understanding where responsibility for vaccine transport and storage would sit on the backend.
I understood things like where a GP surgery fits in, what role an NHS Trust hospital plays in the community, where users feel safe accessing medical care, and where most healthcare providers within a region would be working.
My knowledge of how our very complex healthcare system works in the UK meant that on interviewing healthcare providers, there was a level of understanding already present.
A key consideration for this strand of work was understanding who in GP surgeries would be administering the vaccine. The assumption was that the doctors would administer the vaccines and update the records.
I already had a network of people I knew in the NHS outside of the project (not doctors!) that were able to remind me of the different ways professional bodies worked in this context. It was an unexpected benefit of not only being a fairly new researcher, but having different industry experience.
What was the plan?
Put simply, the plan was to interview medical professionals. In this case we were looking for doctors, which in November 2020 was easier said than done. We were given the opportunity to reach out to multiple networks to interview doctors, but understandably they were busy. Quite likely one of the most inaccessible groups of participants you could come across!
So, I slid into the DMs of an old schoolmate who was a locum GP—a fully qualified GP that fulfills the duties of another, absent GP within a hospital or doctors surgery—and asked if they would be open to being interviewed. They said yes!
Not just that, they were able to put us in touch with more doctors to speak to. We ran interviews on their schedules, usually early morning or in the evening. We were keen to gather the information we needed to understand the problem.
Our team had to create a discussion guide based on some previous research, the aims of the project, and a lot of prior knowledge. The most effective way to do this was to create a document then have specific team members give their input into the questions.
"While we carried out this research, the scope of the project continually chopped and changed, usually due to news updates or changing budgetary requirements. The only way to keep on track with this much chaos happening is to focus on the goal: providing a vaccination service to the British public."
Natasha S. den Dekker
What did we learn?
Our research unearthed the following:
- Our population doesn't all have mobile phones
- They did trust their GPs
- Specific ethnic groups would trust a religious leader over a GP (this echoed other community-led research for a different aspect of the program)
- Letters were their most trusted way of receiving a summons for anything medically related
- Doctors and nurses split the load of the work
While we carried out this research, the scope of the project continually chopped and changed, usually due to news updates or changing budgetary requirements. The only way to keep on track with this much chaos happening is to focus on the goal: providing a vaccination service to the British public.
The stakes were incredibly high. Every part of the service was vital and we were all in it together. Had I not been able to utilize my own network to find participants, we may have struggled to find enough participants to carry out research to pull valid findings from.
Our agency presented the final results to a wide group of stakeholders. The stakeholders spent an hour questioning the research, as everyone was keen to make sure it could be incorporated into the overall project goals sooner rather than later. This was especially true as we had debunked the assumption that text messages were the best way to communicate with vulnerable populations.
With this project we had to be inclusive and account for as many different parts of the population as possible. Less people vaccinated meant more opportunity for the virus to spread and affect more people. Keeping this in the forefront of my mind was how I stayed focused—because every bit of research was useful.
Other key takeaways
Never underestimate what people can achieve
Before this project, I had never considered the impact of the storage and transportation, or how a vaccine would impact the supply chain many steps down the line. Shoutout to some of the most brilliant service designers I’ve ever seen.
Don’t let imposter syndrome get in your way
This project forced me out of my comfort zone, with 1.5 yrs of UX experience at this point, I definitely had strong imposter syndrome! I really valued how my prior experiences meant that I had incredibly pertinent knowledge to supplement our understanding and assumptions. Working alongside researchers who were more experienced than me was intimidating, but it was an opportunity to learn and grow.
Communicate openly and frequently with your team
As a consultant, you’re often airdropped onto projects and into teams where you don’t know anyone. This was magnified because no one had known anyone before this project started, only that some people had been working together for a few weeks longer than others.
The best way to work in this environment was to show up and listen openly and willing to share knowledge. The nature of this project wasn’t about being the lone wolf researcher, but doing the work and sharing as early and as often as possible. By making yourself a trusted source, it meant that meetings and conversations became easier with different departments.
Leverage your existing contacts for maximum potential
This is the time to leverage all your contacts. And contacts of contacts. You can still do this ethically by making sure you're not the one to run the interviews, but be open with your stakeholders with where the participants came from.
The aim is to get the participants. We were relying on the goodwill and generosity of participants, BUT a lot of participants recognized the value of what we were doing, so there was some leeway!
Center the greater goals of the mission
Saving lives is probably the most pressurized environment I've ever worked in. While not the ones administering the vaccine, our team's actions could impact Grandma Daisy because no one had her contact details or knew how to contact her.
Placing the user at the heart of what we were doing helped us zero in on our mission. Focusing on this helps when presenting to stakeholders, and putting this human face on the data helps to keep it real.
The lessons I’ve learned in this project have resulted in positive changes in my own ways of working. While often a solo sport, research can be done with openness and transparency, making sure that you take your team on the journey with you.
Whether it's reaching out for help with recruitment, asking for input on a discussion guide, or getting someone to look over your final report to see if they spot something you haven’t—it goes a long way to building a culture of trust. This culture of trust is a cornerstone for any UX team building its maturity within an organization, but is even more important when everyone is working under stressful conditions and tight deadlines.
Natasha den Dekker is an award-winning UX Researcher at LexisNexis (based in the UK). She currently works on the search capability across varying products. Prior to LexisNexis, she worked for a start-up and varying public-sector focussed consultancies as a User Research consultant, focused on improving government digital services for specific agencies and departments across the English government and abroad.
Prior to being a UX Researcher, Natasha worked as an information professional in the NHS – which involved working alongside clinicians to provide evidence-based research to inform patient care, at Oxfam which took her to Geneva, Kenya, and the Rohingya Refugee Crisis in Cox's Bazaar, Bangladesh. She also worked as a librarian at Microsoft UK which provided her with many of the skills that she uses now! Outside of work, Natasha is most likely to be found planning a holiday, playing the drums, or lifting weights (not necessarily in that order!).
Natasha tweets at: @InfoPro_Tasha and writes (occasionally) at: ur-tasha.medium.com